Posts Tagged ‘Sexuality’
Tuesday, March 11th, 2014
There is a classic episode of Oprah from 1987 that can still raise my blood pressure. That year, the tiny town of Williamson, West Virginia, became part of a national discussion about AIDS when Mike Sisco, who had returned to his home town to die of the disease, dared to step into a public pool.
The community freakout was immediate. Sisco was quickly labeled a psychopath (rumors emerged accusing him of spitting into food at the grocery store), and the town pool was closed the next day to begin a Silkwood-style pressurized cleaning.
Soon thereafter, Oprah Winfrey arrived with cameras for a town hall forum about the incident. Fear was the order of the day. “If there’s just one chance in a million that somebody could catch that virus from a swimming pool,” the town’s mayor told Winfrey’s worldwide audience, “I think I did the right thing.”
Sure. Why not react in the most extreme way possible, if there is a chance in a million?
Williamson citizens were not swayed by health officials who calmly explained the established routes of HIV transmission and the impossibility of infection from a pool. “The doctors can say you can’t get it this way,” a woman countered, “but what if they come back someday and say, ‘We were wrong?’”
Indeed. What if? If there’s a chance in a million…?
That broadcast might have remained a sad footnote in HIV/AIDS history, an instructive example of people ignoring scientific fact to protect a satisfying fear, if history didn’t enjoy repeating itself so much. Today, though, the willful ignorance isn’t coming from uneducated residents of a southern town you can barely find on a map.
It’s coming from gay men. And they are just as threatened, frightened, and dismissive of science as the townsfolk of Williamson were thirty years ago.
Recently, research known as The PARTNER Study was presented at the prestigious Conference on Retroviruses and Opportunistic Infections (CROI). PARTNER proved something HIV advocates have long suspected: people with HIV with an undetectable viral load are not transmitting the virus to their partners. The study included nearly 800 couples, all involved in an HIV positive/negative relationship, gay and straight, with the positive partner maintaining an undetectable viral load. Over the course of two years, more than 30,000 sex acts were reported and documented (couples were chosen based on their tendency to have sex without condoms).
Not a single HIV transmission occurred during the study from someone with an undetectable viral load. If PARTNER had been researching a new medication, they would have stopped the trial and dispensed the drug immediately.
The PARTNER results bolster the prevention strategy known as “Treatment as Prevention” (TasP), meaning, a positive person on successful treatment prevents new infections. To date, there is not a single confirmed report of someone with an undetectable viral load infecting someone else, in studies or in real life.
Just don’t tell that to a sizable contingent of skeptical gay men, many of whom took to their keyboards to dismiss the PARTNER findings. Phrases like “false sense of security,” “positive guys lie,” “junk science,” and “if there’s even a small risk” appeared on Facebook postings and in web site comment sections. The people of Williamson must be slowly nodding their heads.
Resistance to the PARTNER study corresponds with stubborn doubts about PrEP (pre-exposure prophylaxis, or HIV negative people taking the drug Truvada to prevent infection). Although virtually every nervous argument against PrEP has been overruled by the facts, naysayers continue to either reject the evidence outright or make moral judgments about the sex lives of HIV negative gay men on PrEP.
Yes, there are unknowns. There always are when scientific studies meet the real world. And every strategy will not work for every person. But the vehement rejection of such profound breakthroughs suggests there is something more, something deeper, going on in the minds of gay men. What is it?
Our collective memories of AIDS horror are hard to shake, and that’s a good place to start. On a gut level, any study suggesting that HIV could be neutralized is met with a weary doubt. Good news is no match for the enduring grief that has shadowed us for 30 years.
The PARTNER study also threatens the view that positive men are nothing more than risks that must be managed. The study kills the HIV positive boogeyman. It means positive gay men who know their status might actually care enough about their health to seek out care, get on treatment, and become undetectable. And, once the positive partner is no longer a particular danger, both partners would bear responsibility for their actions. What an enormous psychic change that would require in our community.
It’s tough to do that when fear creeps in and “what if?” fantasy scenarios take hold. What if my partner missed a dose yesterday and, even though HIV meds stay in the bloodstream for extended periods, his viral load has inexplicably shot up? What if he isn’t being truthful about his viral load? What if he doesn’t know?
The greater threat, folks, isn’t positive guys who think they are undetectable but are not. It’s men who think they are HIV negative but are not. But we’d rather stay focused on the positive person being at fault, because, well, people with HIV lie a lot. We miss doses constantly because we have a death wish or we’re too busy finding our next victim.
I have some “what if?” questions of my own. What if these unrealistic fears were meant to stigmatize and isolate HIV positive people? What if I am undetectable and feel no responsibility to discuss my status with a sex partner because I don’t care to engage in a science lesson? What if everyone availed themselves to prevention options that worked best for them? What if my HIV status were none of your damn business?
These risks could be alleviated, of course, if everyone simply protected their own bodies when having sex with people they don’t know or trust. But that would place an equal burden on negative men, and what a bother that is. Better to leave that discomfort to those with HIV, vectors of disease that we are. Just consider us criminals, lying to you about our viral loads and spitting in the food in Williamson, just waiting to infect you when we get the chance.
As long as we’re giving undue attention to fantasy scenarios we’re not focused on the real threats. The rates of STD’s are up. Young gay black men in the United States don’t have proper access to healthcare and have infection rates worse than any developed country. Our community is plagued by alcoholism, addiction, and mental illness. Do we want to debate established science or should we devote that energy to other challenges to gay men’s health?
If you still have the arrogance to believe you could win the HIV Powerball Lottery and be the one person who gets infected in ways science has disproven, you’re perfectly entitled to that point of view.
Here are some helpful instructions, however. Carefully step away from your computer and don’t touch the cords because 50 people die of product related electrocutions each year. Walk slowly to your bedroom, being mindful of debris in your path because slip-and-falls kill 55 people every single day. Once there, refuse food or water because, well, you never know. Now slip into your bed of willful ignorance and try to make yourself comfortable.
The good people of Williamson are keeping a spot warm just for you.
p.s. In the time it took you to read this article, the number of people who were infected by someone with HIV who had no viral load was zero.
Monday, January 27th, 2014
“We don’t know the side effects of this drug. It’s too expensive. Insurance won’t cover it. It hasn’t been studied enough. It will encourage slutty behavior. And why the hell don’t people just use condoms?”
– Objections raised to the oral contraceptive progesterone (“The Pill”), approved by the FDA 54 years ago.
When the drug Truvada achieved FDA approval in July of 2012 as a medication to prevent HIV infection among people who are negative (a strategy known as pre-exposure prophylaxis, or PrEP), it’s as if the ghosts of naysayers from the 1960′s rose from their resting places, delighted and re-energized, and began drilling their mid-century objections into the hearts and minds of contemporary society.
Maybe proponents of PrEP like myself believed the response to the drug would be more enthusiastic. Surely anyone who lived through the horror of early AIDS would thank God that a new prevention strategy exists that doesn’t rely upon condoms alone. The fury of the response has been a little startling to me.
Fortunately, Facebook groups and online sites that explain the facts about PrEP are springing up everywhere to address misinformation and to clarify legitimate areas of concern. Here are the most persistent objections to PrEP, and the facts as we know them.
People wouldn’t need PrEP if they would use condoms. They just want to bareback. Studies show that people on PrEP do not have an increase in high risk sexual behavior, but cynics have visions of wanton orgies ahead worthy of vintage gay porn. Alas, what others do in their sex lives is out of our control, whether that drives people up the wall or not.
The facts are these: more than half of gay men do not use condoms or do not use them consistently. This fact has remained true throughout the 30 years condom use has been measured among gay men, including during the darkest years of the AIDS crisis. We can address 50,000 new infections a year or we can have a useless moral debate.
The lack of condom use is what makes PrEP so exciting as a prevention method. The very first large study of Prep was the iPrEX Study, an international study of 2,500 people that was comprised mostly of gay men and some transgender women. The study showed that people who use Truvada as PrEP correctly (taking a pill every day) can have their risk reduced by 90% or more, depending on adherence. Some models show an efficacy rate of up to 99% based on near-perfect adherence.
PrEP is also not dependent on last minute decisions in the heat of passion. Taking a pill in the morning is calmly detached from having sex that night.
PrEP is not necessarily an either/or proposition, because lots of people taking PrEP are also using condoms. But let’s be real. Most people seeking out PrEP already don’t use condoms or they don’t want to use them anymore. Since they are trading one prevention device for something that has a better success rate and is easier to use, what’s it to you?
We don’t know the side effects of Truvada. We have years of data of Truvada side effects on people with HIV (it’s been FDA approved to treat HIV since 2004). Truvada was selected for clinical trials as a PrEP drug because of its favorable safety profile.
It is true that there are some reports of bone density and kidney problems among people with HIV using Truvada as part of their treatment regimen. These side effects have sometimes been serious. We can’t assume the experience of HIV negative people will be the same, and that’s why Truvada patients, positive and negative, should be routinely tested for bone density and kidney function.
More and more HIV negative writers and bloggers (and even a gay porn star) are sharing their experiences on PrEP but, thus far, side effects haven’t been part of their story. Watching them share their progress publicly over time should be quite interesting.
Understanding side effects is part of the assumed risk we take with medications, as any television commercial for a pharmaceutical drug will attest. If you don’t want to cough up blood, for instance, or have bloody stools or nausea or a ringing in your ears, don’t take aspirin. Those side effects are uncommon, and so are the side effects for Truvada.
People taking PrEP also have the option of discontinuing Truvada depending on life events and necessity. Maybe you stop dating the HIV positive guy, or take a break from casual sex, or return to condoms for a while. Starting and stopping the drug in this way does not lead to resistance as long as a medical professional verifies you are HIV negative before restarting.
If you are wary of Truvada side effects, don’t use it. And allow others to make that same determination for themselves.
PrEP is too expensive and insurance won’t cover it. This argument is losing steam rapidly. The Affordable Care Act in the United States is underway and by all accounts every insurance company as well as Medicaid is covering Truvada — although it may require pre-authorization from a doctor for use as PrEP (the CDC has produced a handy document available online to help explain PrEP to your physician).
For those without insurance or money for a co-pay, Gilead (the maker of Truvada) has a patient assistance program that can provide the drug outright or supply co-pay cards worth up to $200 per month. Even if none of this were true, the potential benefits of a drug should not be assessed solely by its price tag.
The people who need it most can’t access it anyway so what’s the point? It’s a good thing we don’t have this attitude towards condoms. Access isn’t the same as efficacy.
But it is certainly true that young gay black men, whom the epidemic is affecting in shocking numbers, have less access to healthcare. This is a systemic problem and it is unfair, frankly, to expect PrEP to solve it. It is also true that PrEP can be an occasion for HIV negative people to seek care, and once on PrEP they are typically required to have medical follow-ups throughout the year, which offers obvious benefits.
The biggest hurdle is often physicians themselves. HIV negative people may have a doctor unfamiliar with HIV care, much less PrEP, and those doctors are often intimidated by what they see as the complexities of HIV treatment. Until more professional education is done, potential PrEP users must learn to advocate for themselves and share CDC recommendations with their doctor.
People won’t adhere to PrEP and that will create resistant strains. It is true that in some early PrEP trials adherence was a problem. Real life behaviors, though, differ from clinical trials in some important ways.
Trial participants have no idea if they are taking the actual drug or not, and in trials the efficacy of the drug hasn’t even been proven. So, the commitment of trial participants to stay adherent to the drug is less rigorous than users today, who know that the drug works, know they’re getting the real thing, and are invested in remaining HIV negative. People taking PrEP today have more skin in the game, as it were.
For those who do miss the occasional dose, Truvada is somewhat forgiving. The protective ability of the drug doesn’t drop if you miss a single dose because Truvada remains in the blood for up to 72 hours (compare that to missing a condom occasionally, which CDC statistics show to be as risky as never using them at all). That being said, it is optimal and recommended that Truvada be taken consistently each day, and users should take seven daily doses for Truvada to achieve optimal protection.
Taking Truvada alone when a PrEP user doesn’t know they are already positive can lead to resistance and significantly reduce treatment options. Resistance has not been found with individuals who were verified HIV negative at the time they started Truvada, but it has happened in people who became HIV positive due to low adherence.
PrEP is just putting money into the pockets of pharmaceuticals when we have cheaper solutions. I can’t imagine anyone telling HIV positive people not to take their medications because their drugs are making profits for Big Pharma. The argument that HIV negative people aren’t worth a fraction of that investment astounds me. I suppose we should wait until negative people get infected before it’s okay for them make a profit for the drug companies.
And those are the facts as we know them about PrEP. I have no delusions that the debate will calm any time soon, of course. Human nature is far too predictable for that.
Just recently, politician Mike Huckabee addressed a gathering of fellow Republicans. Part of his remarks, delivered half a century after The Pill was approved for contraception, was his belief that “smart” women don’t need the government “providing them a prescription each month for birth control because they cannot control their libido.”
Right. Because birth control, as critics have been saying since 1960, would be unnecessary if women only showed some restraint and didn’t behave like barebacking sluts.
Everything old is new again.
My thanks to HIV advocate Jim Pickett of AIDS Foundation Chicago for his expertise on this issue. Jim is active in the development of rectal microbicides (lubes and douches that kill HIV on contact). Damon L. Jacobs, who writes about his personal experience taking PrEP, also served as a resource.
Sunday, January 19th, 2014
If you’re considering how to best disclose your HIV positive status to everyone you know, here’s one suggestion: learn to sew. Television’s long-running reality hit Project Runway could be holding a spot just for you.
Over the course of a dozen seasons, the fashion competition series has tackled everything from drug addiction to racism to gender reassignment among contestants, and it has hosted more HIV disclosures than any other reality show. The latest addition to the trend is designer Viktor Luna, the contestant who sported the fluttering handheld fan on this year’s Project Runway: All Stars.
Exactly how these disclosures have come about over the years is a study in contrasts, as different as the three HIV positive contestants themselves – and the whims of show producers.
In 1998, season four of Project Runway introduced the world to designer Jack Mackenroth (pictured right), the competitive swimmer, model, and all-around sex symbol who had already been living openly with HIV for 17 years. His casual disclosure during an early direct camera interview during his season showed a man comfortable with himself and his status.
“The producers knew I was positive because we fill out a stack of background information,” Mackenroth told HIV Plus. “They had my entire medical history, like every other contestant on the show.”
Already an HIV advocate at the time, Mackenroth knew the producers would eventually use his HIV as a dramatic device, but “that was fine with me,” he said, “because I saw it as an important tool as well, for HIV visibility and as a chance to fight stigma.”
That opportunity was lost when fate intervened. Before he could disclose to his fellow contestants on camera, Mackenroth developed a serious infection unrelated to HIV that forced him to withdraw from the show five episodes into the season.
“Tim Gunn sat me down and reassured me,” said Mackenroth. “He told me that everything happens for a reason, and in that moment I was like, Yeah, right. I was exhausted and emotional. But the truth is, that show gave me my platform. It worked out great.”
It would be years later until an HIV positive contestant would actually disclose their status to the cast on camera, but when it finally happened it brought all the drama and emotion the famously controlling Project Runway producers could ever imagine.
In 2010, season eight of the series included Mondo Guerra (pictured left), an insanely talented young designer who was as guarded as he was endearing. Although one should be mindful that footage is carefully edited to create characters and increase drama, Guerra certainly seemed like an artist with a painful secret or two.
During a challenge to create an original textile, Guerra designed a graphic print with a conspicuous “plus” sign throughout it. In direct camera segments, he revealed that the design reflected his HIV-positive status but otherwise kept his inspiration to himself, having not disclosed to even his own family at that point.
When pressed on the runway later to explain his design, Guerra demurred again. The judges stared in wonder. The music swelled. Filled with nervous emotion, Mondo haltingly revealed his HIV status as the inspiration for his textile. Viewers saw not only his tears but something more: a humble sort of triumph.
“I feel free,” Guerra said plainly.
Guerra’s disclosure was given generous air time during the episode and was the dramatic centerpiece of the entire season. The moment has been replayed endlessly on YouTube and was shown to a packed ballroom at the 2013 United States Conference on AIDS. It was undeniably inspiring, seemingly spontaneous, and brilliant television.
“Knowing Mondo, I think that happened organically,” said Mackenroth. “Of course, everyone is working nonstop, producing a full season in 35 days. When these vulnerable situations come up, we hardly have time to think it through.”
“When the judges genuinely wanted to know the story behind my print and design, that felt like the right moment,” Guerra told HIV Plus. “So I told them what it really represented and that moment was a turning point in my life.”
If Mondo provided the pinnacle of televised disclosures, the current season of Project Runway: All Stars has given us the most curious presentation of The Big Reveal.
In one episode, designer Viktor Luna (pictured right) and the cast were scampering about, hard at work, and suddenly Luna begins speaking of his great anxiety in voice-over. Something is weighing heavily on him. He takes two designer pals aside and quickly shares his HIV-positive status. His friends say supportive things, they hug, and then they all dash back to their sewing machines as if they’d just had a quick smoke break. Luna’s status is never mentioned again.
Luna’s disclosure, as edited, felt like an afterthought, as if the producers noticed a lull in the excitement and cued Luna to bring on the drama. Producers might have hoped for something touching, but the hurried editing actually minimized the complicated nature of HIV disclosure. Everything about it felt false.
You know we are living in a more fortunate time when the merits of one televised HIV disclosure over another are being argued.
“Regardless of how it’s produced, it’s all a win,” says Mackenroth. “Whenever this or any show combats stigma, the HIV community benefits from it.”
Guerra sees a personal benefit too.
“Personally, it wasn’t until I was open about my status that I started to take better care of myself,” Mondo told us. “For that reason, I applaud Jack’s openness about his status.”
Today, Mackenroth continues his advocacy as one of the creators of the HIV=Equal campaign. Guerra has entered the fashion design stratosphere and is a key player in the Project iDesign Campaign, which encourages doctor/patient partnership. Luna wrote about his HIV disclosure on Huffington Post, sharing the details of his HIV journey that were not included in his Project Runway: All Stars episode.
Nothing is assured, in fame or fashion. Project Runway contestants are often struggling designers who leave whatever jobs they have to compete on the show. For any of them to put their personal lives on the line, to take the sometimes frightening step of revealing their HIV status to the world, takes a special kind of courage.
Many people with HIV may not be fashion designers, but they can certainly relate to that.
(This is a slightly edited version of my essay that originally appeared on the site of HIV Plus Magazine. Jack Mackenroth photo by Stan Madden. Viktor Luna photographed at Mercedes Benz Fashion Week by Fernanda Calfat/Getty Images.)
Monday, December 30th, 2013
The year 2013 was a game changer for My Fabulous Disease, and I want to thank you for your clicks, comments, and shares. I have more confidence as an advocate and a writer, thanks to you, and traffic for this blog more than doubled over last year!
I’m bad at predicting which posts might resonate with readers. My philosophy has always been, “if you build it they will come,” and the rest is up to you. Apparently you have very eclectic tastes, my friends.
In ascending order, the Top Ten Postings of 2013 are…
10. The Inspiring Advocates of the 2013 United States Conference on AIDS. This is a rollicking video recap of the annual event, produced by the National Minority AIDS Council, that brings together the very best our HIV/AIDS service community has to offer. Public health and pharma are there, of course, but I’m always thrilled to meet those who are doing the work on the ground, for local community-based organization working with scant budgets but tons of heart. This video includes a discussion about the generational divide among people with HIV, interviews with multiple movers and shakers, marching bands, and Mardi Gras pageantry.
9. An AIDS Death in the Family. Drawing from my book, A Place Like This, I have revisited the night my brothers’ longtime partner died from AIDS, and the surreal haze that surrounded the occasion. It is about loss, yes, but also about how we cling to social habits during the darkest of times to attempt to normalize things that feel anything but normal. A dying man offering a “parting gift” to me, conversing as if he won’t be gone in a few days, and the dreadful phone calls that a grieving lover must undertake. Yes, it’s rough. But it’s life… and death.
8. Two Minutes of Advice on Testing HIV Positive. This is a clever social media campaign: Healthline, an online health community, has asked people who have been living with HIV to create videos for those who have recently tested positive, known as “You’ve Got This.” Think of it as “It Gets Better” for those with HIV. Of course, I had to create a video in my own peculiar way — something that demonstrates the sense of humor that has served me well over the course of 30 years living with HIV. There are now quite a few videos in this campaign with a variety of messages, and I encourage you to visit the Healthline site; you might find the message you or someone you know really needs to hear.
7. Probing My Anal Phobia. I cannot believe I told you these things, which might be one reason this essay is a personal favorite of mine. Maybe this is about facing your fears, because I hate talking about… anal things. So what did I write about? Anal sex, cleanliness, colonoscopies, and the most outrageous douching disaster I have ever experienced. Yes, that’s right, I went there. And the results will either have you laughing or finding out how to unsubscribe. Sometimes, I just need to write things that are on my mind and try to block out the fact that my Mom follows my blog. Enjoy!
6. The Increasingly Strange Case of Uncle Poodle. Long before the Duck Dynasty controversy blew up, another popular reality show had an off-camera moment that caused quite a stir. Uncle Poodle, the gay uncle from the reality show Here Comes Honey Boo Boo, came out in a printed interview as HIV positive, and further claimed that he had been infected by someone who did not disclose his status — and who went to jail as a result. The details, however, are murky, and say as much about shame and HIV stigma as they do about criminalization laws.
5. HIV and Gay Media: The Vanishing Virus. I suppose I have a lot of nerve. After having the honor of being included in an invitation-only summit of LGBT media representatives, I spend much of my time at the event hounding them, on video, about why they don’t write about HIV more than they do. Fortunately, the participants were honest, thoughtful, and quite candid in their responses. The event was co-sponsored by the National Lesbian and Gay Journalists Association and the video was featured on the main page of their site, so I suppose all is forgiven!
4. Surviving Two Epidemics: AIDS and Meth. My history of crystal meth addiction and recovery isn’t something I am ashamed of, but I don’t write about it as much as I once did. The whole recovery process feels almost too precious to share. But when I was asked to share my story for an ongoing feature in Positive Frontiers about gay men in recovery, it just felt right. This essay is my truth, and maybe it will speak to someone at a time when they are ready to make a change. For information on crystal meth recovery, visit http://crystalmeth.org/.
3. The Beautiful Sadness of Dallas Buyers Club. If anyone has a chance of stealing away an Oscar from Chiwetel Ejiofor of 12 Years a Slave this year, it is Matthew McConaughey, who is transcendent in this illuminating look at one straight man’s response to the lack of FDA approved HIV medications. Some have criticized the film for not showing the impact of gay activists, but that’s part of the point of the film: this is the story of this terribly damaged straight man, and how his prejudices were (somewhat) overcome through his own advocacy, as self serving as it may have been. You can count on one thing: Jared Leto, who played a transgendered friend, will be taking home an Oscar for Best Supporting Actor.
2 (tie). Stop Bludgeoning Young Gay Men with Our AIDS Tragedy. I thought I could say these things that other folks — HIV negative or young gay men themselves — would be crucified for saying. I was wrong. I got crucified, too. Fortunately for my sensitive ego (yes, angry comments still hurt my feelings), many others understood that our history is important and vital to preserve, but it’s not a prevention strategy for the landscape of today. This was more primal scream than writing for me. Perhaps I should learn to count to ten?
2 (tie). The Private War That Killed Spencer Cox. It’s kind of amazing to realize that Spencer, an early activist with ACT UP New York that went on to found Treatment Action Group, died only last December. So much has been written and done in his honor, including ongoing public forums on either coast that address PTSD among people with HIV/AIDS, and how we as a community can best address their (our) needs. This essay, posted soon after Spencer died, explores some of those issues, including trauma, loss, and addiction, all of which Spencer himself wrote about before his untimely death at the age of 44.
1. Your Mother Liked It Bareback. I had the title before I wrote the piece, and that’s probably a terrible thing to admit, because the title alone incensed people (The Huffington Post, which carries my content regularly, refused to post it at all). Another primal scream put on paper, an outgrowth of complete frustration over our refusal to admit that there are other “protections” against HIV that do not include condoms. Despite applauding those who do use condoms more than once in the piece, I was accused of “promoting” barebacking and received my favorite name-calling moment of the year, as a “vile merchant of death.” Even when faced with the facts about undetectable viral loads, or PrEP, some who read this article fell back on 40-year-old worries: “you could get an STD!” Honey, if the worst we have to fear these days is the clap, then sign me up. That just makes me feel nostalgic.
But wait! The Real Winner of 2013: “The Sound of Stigma.” When POZ Magazine asked me to contribute a cover story on HIV stigma among gay men, I had no idea it would become my most widely read essay of the year, by far, without even appearing on my own site. Even more surprising, to me, because the piece is such an indictment of how gay community turns against its own (“We are AIDS itself.”). The posting of the story on Poz.com has been shared 2,500 times and has more than 150 comments, ranging from emotional to angry to heartbreaking. I am proud and yes, humbled, that the article contributed to such an important conversation.
Have a bright, joyful, and healthy 2014, my friends.
Tags: A Place Like This, Aging, aids, barebacking, criminalization, culture, family, gay, gratitude, help others, hiv, meth, physician, politics, recovery, serosorting, Sexuality
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Thursday, November 28th, 2013
My brother Richard smiles a lot. He has an easy laugh. But there was a time, years ago, when he held a poisonous drink in his hands and begged his dying lover not to swallow it. A time when Richard held the concoction they had prepared together and wept.
Emil couldn’t wait. He took the drink from Richard quickly, because the release it offered was something more rapturous than the appeals of his lover of thirteen years.
It was Emil’s wish to die on his own terms if living became unbearable, a promise made one to the other. When that time arrived, however, Richard wanted another moment, just a little more time to say, “I love you, Emil,” over and over again, before the drink would close Emil’s eyes and quietly kill him.
Richard has a charming store in my hometown today, where he sells collectibles and does theater in his free time. The drink was consumed over twenty years ago.
There were people who displayed remarkable courage then. People who lived and died by their promises and shared the intimacy of death, and then the world moved forward and grief subsided and lives moved on. But make no mistake, there are heroes among us right now.
There is a shy, friendly man at my gym. There was a time when his sick roommate deliberately overdosed after his father told him that people with unspeakable diseases will suffer in hell. My gym friend performed CPR for an hour before help arrived, but the body never heard a loving word again.
There is courage among us, astonishing courage, and we summoned it and survived. And then years passed. We got new jobs and changed gyms.
There was a time when old friends called to say goodbye, and by “goodbye” they meant forever. When all of us had a file folder marked “Memorial” that outlined how we wanted our service to be conducted. When people shot themselves and jumped off bridges after getting their test results.
There is profound, shocking sadness here, right here among us, but years went by and medicine got better and we found other lives to lead. Our sadness is a distant, dark dream.
My best friend Stephen just bought a new condo. He’s having a ball picking out furniture. But there was a time when he knew all the intensive care nurses by name. When a phone call late at night always meant someone had died. And just who, exactly, was anyone’s guess.
Stephen tested positive in the 1980s, shortly after I did. A few months after the devastating news, he agreed to facilitate a support group with me. We regularly saw men join the group, get sick and die, often within weeks.
Watching them disintegrate felt like a preview of coming attractions. But Stephen was remarkable, a reassuring presence to everyone, and worked with the group for more than a year despite the emotional toll and the high body count.
There is bravery here, still, living all around us. But the bravest time was many years ago, and times change and the yard needs landscaping and there’s a brunch tomorrow.
There was a time when I sat beside friends in their very last minutes of life, and I helped them relax, perhaps surrender, and told them comforting stories. And lied to them.
Jeremy lost his mind weeks before he died. Sometimes he had moments of sanity, when we could have a coherent conversation before his dementia engulfed him again. It was a time when you were given masks and gloves to visit friends in the hospital.
He was agitated with the business of dying, and told me he couldn’t bear to miss what might happen after he’d gone. I had an idea.
“I tell you what,” I offered, “I’m from the future, and I can tell you anything you would like to know.”
“OK then, what happens to my parents?” he asked. I thought it might be a distracting game, but Jeremy’s confused mind took it very seriously.
“They went to Hollywood and won big on a game show, so they never did need your support in their old age,” I answered. He barely took the time to enjoy this thought before his hand grabbed my wrist, tightly, almost frantically. He pulled me closer.
“When…” he began, and a mournful sob swelled inside him in an instant, his eyes begging for relief. “When does this end?” There was an awful, helpless silence. His eyes beckoned for a truth he could die believing.
“It does end,” I finally managed, although nothing suggested it would. “It ends, Jeremy, but not for a really long time.” He digested each word like a revelation, and slowly relaxed into sleep.
There is compassion here, enough for all the world’s deities and saints acting in concert. Infinite compassion for men who lived in fear and checked every spot when they showered for Kaposi sarcoma, and for disowned sons wasting away in the guest room of whoever had the space. But we get older, and friends don’t ask us to hold their hand when they stop breathing, and the fear fades and I bought new leather loafers and the White Party is coming.
The truth is simply this, and no one will convince me otherwise: My most courageous self, the best man that I’ll ever be, lived more than two decades ago during the first years of a horrific plague.
He worked relentlessly alongside a million others who had no choice but to act. He secretly prayed to survive, even above the lives of others, and his horrible prayer was answered with the death of nearly everyone close to him.
To say I miss that brutal decade would only be partially true. I miss the man I was forced to become, when an entire community abandoned tea dances for town hall meetings, when I learned to offer help to those facing what terrified me most.
Today, the lives of those of us who witnessed the horror have become relatively normal again, perhaps mundane. We prefer it. We have new lives in a world that isn’t choking on disease.
But once, there was a time when we were heroes.
(I was honored to receive an award from the National Gay and Lesbian Journalists Association for this piece in 2007, written to commemorate World AIDS Day. It has since become my annual post to commemorate the day. Here’s to a joyous and healthy holiday season for us all. — Mark)
“Know Stigma” (I hereby pronounce “stigma” the Word of the Year) is a terrific site devotes to photos and video that challenge our attitudes towards one another as gay, straight, femme, old, poz guys, etc. There are some really intimate, honest videos with people discussing the impact of stigma on all aspects of their lives. “We want to create a conversation around how we treat each other as gay, queer, bi, trans, and straight men,” says their site. “Like everyone, we have our biases and prejudices. Many of us are made to feel invisible because of age, body type or skin color. How can we say what we want without hurting others? How do we imagine our actions and words might make someone else feel?” Check it out.
After a lot of talk about HIV stigma, there is now a project in the United States that wants to actually quantify it and address it through leadership by people with HIV. “The People Living with HIV Stigma Index” has been launched in dozens of countries but only now has received funding to implement it in the U.S. It measures HIV stigma in the lives of people with the virus, and does so by training and employing people with HIV themselves to conduct the surveys. Watch a video of Laurel Sprague of the Global Network of People Living with HIV discussing stigma and this project with Eric Sawyer of UNAIDS.
Tags: Aging, aids, culture, gay, help others, hiv, physician, politics, research, Sexuality, testing
Posted in Family and Friends, Gay Life, Living with HIV/AIDS, My Fabulous Disease, News | 3 Comments »
Thursday, November 21st, 2013
Lesley was my closest friend to become sick in the 1980′s, and he fought bravely until his death from AIDS. Today, there are little rituals I have to honor his memory, and I often write about him, the first of many friends lost to the epidemic.
But there’s something I will not do. I will not dig up Lesley’s body and beat young gay men with his corpse. Lesley didn’t perish so I could use him as a scare tactic. He wasn’t a cautionary tale. He wasn’t a martyr. He was a man with the same passions and faults as anyone else, and I won’t use his death as a blunt instrument.
Plenty of us are more than happy to rob graves, however, in an attempt to frighten gay men into acceptable behaviors. This kind of horror-by-proxy happens all the time. Concerned but misguided gay men of a certain age hear whatever the latest HIV infection rates are, and they pull the AIDS Crisis Card.
“If their friends all died like mine did, maybe they would think twice before having sex without a condom,” goes a typical remark, drenched in self pity and tenuous logic.
This statement misrepresents our lost friends and oversimplifies the state of HIV today. It projects our grief in the direction of those who bear no responsibility or resemblance to what we experienced. It subtly blames our departed friends for their mistakes, and then tries to equate them with a new generation of gay men who are much too smart to buy into it.
So frozen in time is our victimhood, it hardly allows for the facts of the here and now. Young gay men are more aware of HIV than my generation ever was. They simply relate to it differently, having come of age since the advent of successful treatments. Asking them to fear something they have literally grown to accept is as realistic as asking them to perform “duck and cover” drills in case Russia drops the bomb.
To view these young men and say, in effect, “if only you saw all the death that I saw…” is a wishful fantasy that disturbs me on all sorts of levels, and it says far more about us than it does about them.
I understand these attitudes come from a place of complicated emotions, ranging from grief, primarily, to our own shame or guilt over dodging a bullet — and it may come from a sincere need to share our experience with others. The punishing tone that often accompanies it, though, isn’t going to win the respect or investment of younger men. It makes us as relevant as old men on the front lawn waving a rake at youngsters.
I take our community history very seriously. I’ve written a book about the dawn of AIDS in Hollywood, have read And the Band Played On more than once, cheered on the activists in the documentary How to Survive a Plague, and can’t wait for the release of Sean Strub’s upcoming AIDS memoir, Body Counts. There is enormous value in preserving our history — and in recognizing that many of us still carry trauma born of that time.
Community advocates have stepped up work to help us process what we went through a generation ago. Post Traumatic Stress Disorder (PTSD) is a very real phenomenon for longtime survivors, and excellent community forums have been mounted to explore these areas by the Medius Working Group in New York City and the “Let’s Kick (ASS) AIDS Survivor Syndrome” project in San Francisco. Hopefully, other cities and LGBT organizations will follow suit.
That important work is quite different, however, from allowing our past to blind us to the present. When we raise our finger and say in a voice filled with foreboding, “people think you only have to take a few pills and that’s it,” we are denying the actual experience of a lot of people with HIV. For many like me, taking a few pills a day is, in fact, the only impact HIV has on my life. Research suggests I will live a normal lifespan and am more likely to die from cigarettes than HIV. And I’m not going to deny all that in order to advance a fright-show storyline that isn’t my experience.
There are young voices telling new stories, thankfully. Gay writers living with HIV such as Patrick Ingram, Josh Robbins, Tyler Curry, Aaron Laxton, Robert Breining and the irascible Josh Kruger are peering across the generational divide (I have HIV antibodies older than they are) and they seem bemused. Their blogs suggest a post-AIDS life of full engagement and purpose. I consider this progress. If their lives (and writings) don’t include burying friends or serious health concerns, wasn’t that our goal all along?
Nowhere has our AIDS tragedy mindset done more damage than in the rollout of the unfairly maligned Pre-Exposure Prophylaxis (PrEP), the prevention breakthrough that allows HIV negative people to take anti-HIV medication to avoid infection. It is largely viewed as an alternative to condoms, which has quickly labeled HIV negative men taking PrEP as “barebacking sluts” by people coming unhinged at the very idea of unprotected sex. (Note: I remember when gay sex never involved condoms. It was glorious. I always thought getting back to a place where we had a real choice in the matter was kind of the point.)
There is something about the simplicity of PrEP (a pill a day! no condom negotiation! no guilt or judgment!) that is driving older gay men up the wall, considering their resistance to it and spurious claims of inefficacy, cost, and side effects. Tellingly, younger gay men have voiced fewer objections.
The facts are these: PrEP is at least as effective as condoms when used properly. The drug currently used for PrEP, Truvada, is well tolerated with few side effects. And despite fears and misinformation, it is being covered by insurance providers (do you know of even one claimant that has been denied?). For those without insurance, Gilead, the maker of Truvada, has a generous patient assistance program that allows you to earn a sizeable income and still get the medication.
Perhaps, in the end, we are simply victims of our own success as advocates. We successfully entrenched the immediate, mortal danger of HIV, the shameless inaction of our government, and the profit-driven, opportunistic role of the pharmaceutical industry. Anything that veers from that narrative, especially for those of us who lived it, feels like betrayal. Yet here we sit, in an age that confounds so much of what we once knew to be true.
The 1980′s are history. They are not a prevention strategy. The war as we once knew it to be, the one Lesley and so many others fought so valiantly, is over.
May they rest in peace.
My friend and early mentor, Eric Rofes, was an out, gay, kinky, deep thinking anthropologist that wrote the important book Reviving the Tribe, about building community among gay men during the AIDS epidemic, and Dry Bones Breathe, his follow-up work. He was one of the first to write about the value and even spiritual importance of anal sex for gay men and even exchanging bodily fluids (when he said as much at a forum for gay men in Atlanta I organized in 1995, it was as if a bomb went off, such was the hysteria). For a thoughtful overview of Eric’s work and influence, check out a piece from Charles Stephens about the Rofes legacy — and where his worked wasn’t fully realized. Whenever I fear my writing might seem provocative, I think of Eric Rofes, his bravery, and his lasting influence on the work of many of our leaders. Eric died far too early in 2006 of a heart attack. (Photo credit: Markichester.com)
Tags: A Place Like This, aids, barebacking, culture, gay, hiv, physician, serosorting, Sexuality
Posted in Family and Friends, Gay Life, Living with HIV/AIDS, My Fabulous Disease, News, Prevention and Policy | 33 Comments »
Wednesday, October 30th, 2013
I don’t write about my drug addiction very often anymore. There’s no shame there; I’m really proud of my recovery process. It just seems too delicate, too precious to share as publicly as I do my journey with HIV. That’s interesting, considering of the two diseases, my addiction is far more likely to kill me. So, when a member of The Tweakers Project invited me to contribute to an ongoing column in Frontiers magazine that spotlights people recovering from meth addiction, I felt it was an appropriate venue to briefly share my experience. Here is my column as it appeared in Frontiers:
I thought I had a right to get high; that I deserved it for all my pain. I figured any gay man who suffered through the 1980s needed to medicate. Living in West Hollywood as a young man, I was dodging bullets in a war zone, busily planning memorials and attending town halls while hoping to God I wasn’t next. My prayer was answered but came with a price — watching scores of men die around me.
Pop a pill. Snort a line. Check your nose and visit your friend in the ICU. Maybe others found healthier ways to cope, but I wasn’t equipped for the onslaught of mortality, the preachers on television proudly announcing the evidence of God’s wrath against people like me, the dire news that no medications could combat this plague and my own HIV-positive test results. I couldn’t comprehend my emotions, much less face them. So when treatments improved years later and the dying abated, I felt entitled to celebrate.
Pop a pill. Smoke a bowl. Stash the drugs and get back on the dance floor. That’s when I knew I was a drug addict. When any occasion qualified. Whether we were dying or living, I was high. Maintaining a functional existence slipped away, just slowly enough not to alarm me, as if the drugs were quietly sneaking out the door with my life. And along with it, all those broken promises it made about euphoric deliverance and endless nights of pleasure.
There wasn’t a single event that brought it to an end, because the truth is my recovery from drugs has been uneven and imperfect. Through the help of professionals and fellow addicts, I have slowly gathered the tools I need to remain clean and sober. Vigilance. Patience. And more honesty than is ever comfortable to me.
For the last 10 years I’ve been climbing back out of a hole I had finally stopped digging. I’ve managed to locate the man I had once hoped to be. I have found my joy again, which is truly the guiding emotion that helps me remain clean. I have come to terms with surviving AIDS and for living when so many worthy men did not. I have forgiven myself for having such good fortune and responding to it by sticking needles in my arm.
Today, my health and recovery are primary to my daily life. I have regained gifts and talents that had laid dormant for many years, and I use them in the service of others.
As a writer and HIV activist, I’m known for my sense of humor. But I’m dead serious about my addiction. I don’t want to go back there. I love this life too much.
Photo credit: Fulton County Sheriff Department, after my arrest for drug possession in February of 2008. If you have an issue with substance abuse, help is available. Consider programs like Alcoholics Anonymous, Narcotics Anonymous or even Crystal Meth Anonymous (find out more about 12-step programs here and if one would be right for you), or check out reviews of treatment centers available at TheFix.com.
Other Posts on Drug Addiction:
“The Crystal Meth Connection of the Gay Porn Killer.” If ever a posting had enough searchable Google words, this might be it. A look at the Canadian accused murderer and why his alleged meth use made sense to me.
“My Muscles, My Disease: A Snapshot of Drug Addiction.” How my body-conscious lifestyle only fueled (and still reminds me of) my drug addiction.
“The Long Road Home from Relapse.” Assessing the destruction of a harrowing relapse as I drive a thousand miles home to family.
He calls it an exhilarating “exercise in perversion,” but I call it fascinating. A prominent gay health advocate who blogs anonymously as Promiscuous Gay Nerd asked himself the question, “What makes sex good for me?” To find out, he created a spread sheet and then tracked every sexual detail of 50 encounters (43 of them unique, living up to his promiscuous name). Reading his analysis and viewing the spreadsheet in all its grinding glory is a lesson in gay sex, pursuit, and why we chase “the strange” rather than “the intimate.” More ironic is the fact that the blogger rates the more connected and intimate encounters as the best ones. Might there be a lesson there about hanging up his promiscuous lifestyle and finding an ongoing partner? “I had boring sex with boyfriends sometimes, just as I have boring sex with strangers sometimes,” he told me in an online comment. “Perhaps that’s why all my exes are exes! I look forward to finding a man who can change that.”
“Travels With My Nephew” is a new book of fiction that covers the life of Dorothy DeMoore, a proper British woman with enough Auntie Mame in her bones to satisfy her gay nephew. Their adventures take them back and forth across the pond, as her horny nephew samples love and Dorothy learns lessons about cabarets and gay rights. The story is told by Dorothy to the writer of her memoirs, and the interplay between the two as she weaves her tale provides droll entertainment. Curiously, the occasional references to the dawn of AIDS seem out of step with an otherwise pleasant comedy of manners. But no matter — author Guy Wilson (of the Wilsons Arts Project, which has produced the book as a theatrical musical) keeps things moving at a fun clip. The cover photo of Dorothy (above), I might add, looks suspiciously like Guy’s husband, Nic Wilson. Just sayin’.
Our favorite poz fitness and nutrition expert Nelson Vergel (people still write me about the funny and informative video he and I did together, when Nelson raided my fridge to teach me a lesson) is involved in a new health site for men, ExcelMale.com, that provides nutrition and supplement information and forum chats with other people. It is not specific to HIV but does have great info. It offers a free membership to participate in postings (and they do hope you’ll purchase their products), but I was able to wander freely on the site and get good info without signing up.
Tuesday, October 22nd, 2013
Just because it’s over
doesn’t mean it didn’t happen…
Doesn’t mean it wasn’t beautiful,
even with the pain.
– “Beautiful Sadness,” sung by chanteuse and gay favorite Jane Oliver
In the first minutes of Dallas Buyers Club, the astounding new film about the darkest years of the AIDS crisis, rodeo cowboy Ron Woodroof (a gaunt and barely recognizable Matthew McConaughey) is punched in the face. He has it coming. The self-serving crook has a lot of enemies.
The blood spills from his mouth and glows a bright crimson, an almost clownish contrast to his drained, ghostly pallor — which itself is evidence of a raging HIV infection he has yet to discover. Another gash on his forehead is a sickly collection of reds, and unlike most movies in which injuries disappear by the next scene, the wound remains. And remains. For many scenes thereafter, the blood on Woodroof’s forehead is in full view, a disconcerting reminder of what lies beneath, until you wish he would just put on a bandage already.
But Dallas Buyers Club isn’t interested in making the truth very pretty. A river of infected blood runs through it. So, too, does practically every other bodily fluid, along with bruises that won’t heal and purple skin lesions and flakes of dry, reddened skin. And that’s kind of beautiful. Because that’s what AIDS looked like in 1985, and it’s been ages since we have fully remembered it (this movie doesn’t concern itself with the modern day notion of “living with HIV,” since having the virus in those days typically meant an AIDS diagnosis and fast and efficient death).
I have never seen AIDS shown this way in a film. And of all the movie portrayals of the disease, from Parting Glances to I Love You Phillip Morris, nothing else has captured the ugly physicality of the disease like Dallas Buyers Club. Even the tearful hospital bed goodbyes in Longtime Companion seem overly romanticized by comparison.
The based-on-a-true-story concerns Woodroof, a hard living cowboy and drug addict, who must face certain death and the cruelty of his redneck buddies when he tests HIV positive. Woodroof also lives the sheltered life of a southern homophobe, so watching him negotiate the AIDS community terrain of queers and drag queens is fascinating viewing and provides some of the surprisingly plentiful humor in the film.
But Woodroof hasn’t successfully dodged the consequences of his petty crimes for nothing. He quickly cheats the system to acquire the poisonous medication AZT and, after an eye-opening trip to Mexico, he figures out how to profit from the sale of unapproved drugs to the throngs of support group members back home.
Along the way he allows himself a guarded friendship with a drug addicted transgendered salesperson, Rayon (Jared Leto in an effective and quietly humble performance), and eventually accepts to some degree the gratitude and generosity of the many gay people around him.
Nearly everyone in the story, patients and physicians alike, is a wretched outcast, damaged by drug addiction or homophobia or loneliness or their own destructive behaviors. No one is healed, no one fully conquers their demons, and no one gets out unscathed. The fact that the filmmakers make you root for every one of them is a testament to terrific storytelling and a vexing main character you grow to love and admire.
These characters also live a world away from the more sophisticated New York City activists that populate the Oscar-nominated documentary from last year, How to Survive a Plague. In fact, the big city AIDS battles being waged elsewhere barely register in this story about southern vice and ingenuity. When Woodroof and his rodeo buddies first learn of the death of Rock Hudson, the actor is dismissed as a cocksucker, except for one of them who doesn’t know who Hudson is. His buddies scoff. “Haven’t you ever seen North by Northwest?” one asks.
Woodroof’s entrepreneurial efforts ultimately create the Dallas Buyers Club, a real business that provided unapproved medications to very desperate people with AIDS. As someone who once used a buyer’s club to purchase Compound Q and other pharmacological footnotes in HIV/AIDS history, I can attest that everything from the cheap cinder block setup in the film to the anxious expressions on the customers felt tragically familiar.
The real villain in the story, other than the virus itself, would have to be the early, toxic drug AZT and its manufacturer. Although the film uses a fictional pharmaceutical name, let history show that AZT was produced by Burroughs Wellcome (eventually absorbed into Glaxo SmithKline), who downplayed side effects in a complicated rush by the FDA to have a drug, any drug, to treat the growing pandemic.
Matthew McConaughey is a revelation. His physical transformation alone would be Oscar bait were it not for his ability to gain our affections for such a self-serving swindler. Calling the performance free of vanity is an understatement. His harrowing depiction of living with AIDS makes the award-winning Philadelphia look about as realistic as Dark Victory. It reminds me of when we settled for scraps in Hollywood’s depiction of AIDS, when any major actor brave enough to play a gay man won an Oscar.
There is a moment late in the story during which Woodroof checks himself in the mirror before an evening out. Suddenly he finds himself staring, and in the dim bathroom light he sees the undamaged face of the man he might have been. He allows the slightest expression of pride, for the things he has accomplished, for those he has helped. And then, as those of us who lived through the 1980′s know so well, the face returns to a look of both hope and despair, of the beautiful sadness that always brought too many questions about the fate that was barreling towards us.
It is that face in Dallas Buyers Club, the one free of blood and injury, that is the most haunting of all.
(Photo credit: Anne Marie Fox / Focus Features)
For those who survived the deadliest AIDS years of the 1980′s, there is a growing movement to address the kind of post-traumatic stress and “crisis of meaning” that has plagued many of us. Some of this comes as a response to the death of activist Spencer Cox last year, although it is a long overdue issue to be addressed. You might appreciate coverage of the New York City forum held earlier this year, “Is This My Beautiful Life?” (a video recap is here)or the more recent forum in San Francisco, “Kick ASS (AIDS Survivor Syndrome)” (with a video chronicle of the event here). My hope is for more forums like these in other cities, and an ongoing, programmatic response from service organizations to respond to these issues.
Friday, October 18th, 2013
We have learned through the last decades of the LGBT movement that the most effective way to change perceptions is to come out. It forces people to face their prejudices and it is almost always a positive experience, even in the face of potential discrimination.
So why, then, don’t more people come out about being HIV positive? No one is more familiar than I am about the perils of living with HIV in terms of everything from social stigma to draconian criminalization laws. This kind of repression makes it all the more important that the rest of us make ourselves visible to help change those attitudes.
Who knew that 30 years into the HIV epidemic, it would still be viewed as courageous, even radical, to be public about your HIV status? And at a gay pride parade?
And yet there we were recently, a dozen brave souls marching the length of the Atlanta Gay Pride parade with HIV POSITIVE emblazoned on our t-shirts (I got the fab shirts from AIDS Foundation Chicago). I was participating as one of the Grand Marshals for the event, an honor I was prepared to make jokes about but can’t really bring myself to do it. It was humbling in a very sincere way, and since those moments are rare for me, I’m going to leave it at that.
Well, except I’m going to ask you to watch this short video blog of the event, below. There’s something special in it for those of you who are also making a difference when it comes to HIV. Enjoy and share!
I consider it a privilege to be open about my HIV status. I know that I am fortunate not to have consequences as a result — not from my family, not from my job, and not even from the treacherous dating scene, since I’m partnered to a wonderful guy (although I was out about my status even when I was single). I know that for some people, staying private about their HIV status is a matter of personal safety.
But I believe a lot more people could be open about it, and their only reason for not doing so is fear. That’s a powerful emotion. But fear alone doesn’t excuse us from watching others being stigmatized and not letting our community know that there are more of us than they imagine. Why make those of us who are open about our status look radical, or as exceptions to some social rule that paints a distorted picture of who we are? I’m afraid there are too many people living with HIV that are letting too few of us do the heavy lifting in that regard.
I hope you will give this some thought. What are the consequences of your sharing your status with others, when HIV enters the conversation? Are they really that dire? Is the risk of some social embarrassment really enough to deny your identity as part of a large group of people battling an indiscriminate virus?
I don’t want to be a radical. I just want to live a truthful life and know who my friends are.
ACTION ALERT: This is an easy task and I urge you to do it right now. The CDC’s Advisory Committee on Immunization Practices is meeting this week to decide whether to add the bacterial meningitis vaccine to its list of recommended vaccines for infants and children. I strongly believe they should (kids under 1 are at greatest risk of contracting the disease!), and it’s important for the LGBT community to be engaged on this issue. Thousands of same-sex couples are raising children, and a stronger herd immunity protects those in our community with compromised immune systems, including people with HIV. TO ACT, sign this petition started by John Becker of The Bilerico Project. For more information, read John’s posting about the issue. Have you clicked the petition link yet?
YOU MIGHT ALSO LIKE THESE POSTS: “The Stupid Question: Are You Clean?” confronts the kind of social stigma I discuss above. And “Is There Pride in Being HIV Positive?” is a video blog from last year’s Pride celebration that poses the question: if HIV is nothing to be ashamed of, it is something to be proud of?
Tuesday, September 24th, 2013
Note: This essay has been shared more than 15,000 times from this site since it posted in July of 2012. Some readers responded angrily, and the barebacking aspect of the story brought both cheers and derision (one comment accused director Max Sohl of “crimes against humanity”). Frankly, I just thought the story of the film and its sociological impact was worth investigating; I appreciated the candidness of those connected to the film, as well as the social scientists and CDC officials who served as background.
The annual Folsom Street Fair in San Francisco is noted for its unbridled embrace of every star in our sexual constellation. Even the fearless leather community that founded the event can sometimes appear tame amidst the outlandish kinks and clothing – and lack thereof – on display along the city’s tilted streets.
In the middle of this rowdy bacchanalia in the fall of 2003, Paul Morris stood at the booth for Treasure Island Media (TIM), the gay porn outfit he founded that features unprotected sex (barebacking) between its actors. This particular specialty was the singular driving force behind his smashingly successful and relatively new company.
Then, like the legend of Lana Turner fortuitously cozying up to the counter at Schwab’s, a beautiful and achingly masculine young man approached the TIM booth. He liked the TIM videos, he liked them very much indeed, and he hoped to one day document a few fantasies of his own. TIM star Jesse O’Toole was on hand and someone snapped a photograph of the two of them together (right). In it, the grinning young man with a leather cap appears to have found his long lost tribe, and O’Toole looks as if he has found a seven-course meal.
The photo was sent to Max Sohl, a sometime porn actor with a theater background whom Morris had commissioned to conceive and direct what would be Sohl’s first porn film. Sohl met with the aspiring model and asked him to complete a form that included a simple question: What is one of your fantasy scenes? In response, the young man wrote simply, “me getting nailed and seeded by a gang of hot guys.”
“The Black Party was coming,” Sohl explained in a recent interview, referring to the annual New York City weekend of leather men, parties and sexual adventures, “and I thought, ‘Okay. Let’s see how many men he can take.’”
And that is how Dawson’s 20 Load Weekend was born.
Prior to the onset of AIDS, condom usage in gay pornography was nonexistent – but that was before bodily fluids became synonymous with death and disease. For well over a decade after the crisis began, gay porn videos featured not only tightly wrapped penises, but their storylines – indeed, the actors themselves – suffered from a sort of dramatic malaise, as if sleepwalking through their sexual routine while trying to pay no attention to the man with KS lesions behind the curtain. The videos mirrored our own lack of interest in gallivanting about with the pizza man or diving into an orgy with strangers, with or without condoms. Many viewers simply returned to their stash of pre-AIDS pornography, which was condom-less but “justified.”
As AIDS deaths subsided with the advent of new medications in 1996, gay male culture responded with a vengeance. Circuit parties were born of celebration (before succumbing to their own excesses), safer sex behaviors relaxed, and there was a palpable longing to escape the horrors of the previous years. Reclaiming a bold sexuality – something many gay men believed had been lost forever – was a tonic for the post-traumatic stress they suffered. Younger gay men, who had listened to stories of an earlier, sexually liberated time as if it were a lost era of paleontology, were more than willing to explore whatever modern version might await them.
Unprotected sex since the arrival of HIV is nothing new – it is, after all, the primary reason for new infections that have continued fairly steadily since AIDS began – but in the late 1990’s the gay community proved again how comically adept it is at applying a little branding to any phenomenon, and “barebacking” entered the public lexicon. The irony may be that a new word was developed for the oldest sexual activity imaginable: having sex without a barrier. It wasn’t the sex that had changed, but the meaning and judgment associated with it towards, most specifically, gay men. Or, as AIDS advocate Jim Pickett said at a recent conference for people living with HIV, “When a friend announces they are expecting a child, I feel like screaming ‘You barebacked!‘”
But while intelligent minds and passionate advocates argued about the reasons and the proper response to barebacking, no one had dared document it on videotape for the erotic pleasure of others. Yet.
In 1998, two renegade companies formed to make bareback videos exclusively: Hot Desert Knights and Treasure Island Media (links definitely NSFW). None of the leading gay pornographers would consider producing them (although they were eager to market their highly-profitable backlists of videos produced “pre-AIDS” that featured bareback sex). The cheaply made videos by the upstart porn producers brought the sexual choices of an increasing number of men out of the closet and onto DVD players and computer screens.
The videos were uniform in their low production values, the older ages of the actors, and the fact that several of them appeared to have the physical manifestations of HIV. It was as if a group of men who had literally lived through AIDS said, “oh, what the hell,” and demonstrated the kind of sex they had been having amongst themselves for some time. Their exploits were perceived as an underground fetish that would never break the surface of more mainstream gay pornography.
But then Max Sohl met that ferociously attractive man from the Folsom Street Fair who was so eager to “get seeded” by a string of strangers, and with the sexual zeitgeist now primed for their arrival, they made a film that would forever change the porn industry and quite arguably influence the sexual behavior of countless gay men.
Re-christened “Dawson,” the budding porn star was served up in a hotel room over the course of New York City’s 2004 Black Party weekend to an ongoing parade of bareback tops. Their sex was filmed in a documentary fashion, without music, scripted dialogue, or any effort to hide the many cables and cameras crowding the room. Dawson’s fantasy had been fulfilled, and Sohl had the footage to prove it.
In June of 2004, Dawson’s 20 Load Weekend was released and was precisely as advertised.
It might first strike the viewer that the video was created in an unsettling world in which HIV is utterly absent; that is, until a revamped sexual choreography is pointedly repeated again and again. While orgasms in gay porn before AIDS typically showed the top withdrawing from his partner and spilling his semen across his partner’s backside, the tops servicing Dawson had a different and very deliberate mission: to withdraw only long enough to prove their orgasm, and then re-enter Dawson immediately to show the injection of semen.
This was not a film that was made in the absence of HIV, but was created because of HIV. You can practically hear a disembodied voice whispering, “Watch closely. This is how gay men have sex now. That is where semen belongs. Fuck AIDS.”
Depending on your point of view, it is either a transgressive act of eroticism or an incredibly irresponsible act that demonstrates how to become infected with HIV. Or perhaps both.
In the center of all of this was Dawson himself, and never has bareback porn had such a virile and athletic leading man, much less one that bottomed with such disarming delight. “He was a higher quality male model that hadn’t been seen in that kind of extreme scene,” said Sohl. “The movie changed things because of Dawson. He was adorable, and actually smiles and laughs. He is Cialis joyful in that movie.”
“Bareback porn companies have blood on their hands,” became a common refrain among gay men and health advocates. Gay sex advice columnist Dan Savage equated the videos to child porn, believing they take advantage of the naïve and the vulnerable. Some accused TIM of making snuff films.
The video was wildly successful, ubiquitous wherever porn was shown. Even Sohl was surprised. “Our staff and even my friends would say ‘I go into a porn booth, a sex party, a hookup, and its playing,’” he said. “It was everywhere.”
Adult bookstores which had previously shunned TIM videos responded to customer demand and began stocking them, even creating bareback sections on their shelves. Gay porn sites that once refused to feature bareback clips began including them. Dawson and the film became the definitive symbol of a bare, wanton sexuality that eschewed condoms and refused to be denied or intimidated by the virus.
Soon, more companies produced bareback porn, and they were able to attract “collegiate jock” types who were younger, more muscular and the very picture of health and vitality. The faces and bodies in bareback videos had been transformed, erasing all evidence of HIV, much like the invisibility of HIV/AIDS in our broader culture.
When considering the legacy of his film, Sohl is more pragmatic than proud. “The concept of taking twenty loads in 2004 was beyond taboo, but to say it in 2012… it doesn’t seem as extreme today,” he said. “I’m sure someone else would have done it. It just so happened to be us.”
Neither does Sohl admit to any trepidation about the safety of his actors, then or now. “I’ve been doing this since 2004, with thousands of men, and have had only one guy claim to get an STD (on my set),” he explained. “Probably 50 percent of my casting job is being an HIV counselor,” he adds, without a hint of irony. “I spend a lot of time talking about HIV. My feeling is that people need to be responsible for their own actions and make informed decisions.”
One of the people making decisions while living with HIV is none other than the actor known as Dawson, who disclosed his HIV positive status to The Windy City Times in 2005. While his HIV status may surprise no one, something else he said in the interview was sadly revealing. “It was after turning positive that I made the decision to look into doing a movie for Treasure Island Media,” he said at the time. “I had seroconverted a few months before…”
After an HIV diagnosis, many people use it as an opportunity to re-examine their lives, make different choices, or otherwise take steps to enjoy their life in whatever ways are important to them. For the man who would be Dawson, his seroconversion was followed by the choice to be an unapologetic cum whore in front of video cameras. This may have been his fantasy, but it certainly fuels the stigmatizing belief that people with HIV are irresponsible vectors of disease, spreading infection and abandoning whatever sexual values they may have previously held.
Perhaps, then, the film was a treatise on the kind of sexual liberation available to HIV positive gay men today, demonstrating the “new normal” for those who take their meds, eliminate the viral activity in their blood, and “fuck freely and without fear,” as TIM founder Paul Morris once put it. Or did it simply portray poz men as sluts, a charge leveled by disgusted (and possibly jealous) HIV negative men?
“What a person is seeing has more to do with them than with us,” said Sohl. “The best mode of action is not to confirm or deny anything. I will see a scene online that I directed,” he says, referring to the many porn sites that pirate pieces of his work and give them new titles, “and it will be renamed ‘negative bottom takes poz loads,’ as if it were a conversion scene. We never said that. Or people think the bottom is using crystal meth. That says more about the guy watching it than what actually happened.”
That relationship, between porn and viewer, is something of particular concern to some HIV prevention advocates who believe bareback porn encourages unsafe sex in real life. This resulted in AIDS Healthcare Foundation’s recent campaign to mandate condom use on pornography sets, a move that was popular on a simplistic level but did nothing to address the myriad of factors associated with actual HIV risk and relative safety, such as an undetectable viral load, serosorting, or the precise sexual behaviors involved.
While social cognitive theory states that we make behavioral decisions based on watching others, very little research has been conducted on the causal relationship between bareback porn and real behavior. In what little has been studied, researchers can’t decide if barebackers watch a lot of bareback porn, or bareback porn makes people barebackers.
It is a riddle that Max Sohl is surprisingly happy to solve. “Absolutely” he said. “Of course it is going to influence what people do.” When asked, then, what is the responsibility of porn, Sohl would have none of it. “The responsibility of porn,” he says impishly, “is to make the guy watching it shoot a load.”
Dawson is, now and forever, committed to videotape and featured on dozens of online porn sites, happily receiving the prize he so ardently desires. He and his progeny of newer, younger porn actors have crossed a line and they’re never coming back. Their video escapades are available online everywhere and for everyone, including young gay men who are just coming out and surfing the internet for validation of their sexuality.
What those young men will almost certainly see online are depictions of unprotected sex, because bareback videos now outperform scenes of condom usage on every site that carries them – and most of them now do. It is unquestionable that bareback sex will be viewed as typical to the uninitiated, and anyone crafting safer sex messages to those young men is going to have a difficult time trumping those images. The “use a condom every time” message is officially dead, drowned in buckets of bodily fluids by Dawson and his barebacking brethren.
Dawson’s 20 Load Weekend redefined bareback porn and the men who appear in them. It influenced subsequent videos and expanded the availability of bareback films. It depicted a prevailing truth about gay sexual behavior “post AIDS,” and arguably encouraged risky sexual adventure-seeking. It led to the saturation of bareback porn online, making unprotected sex normative to whomever might be watching. To dismiss this film, to minimize its social and cultural impact, would be to demonstrate a profound misunderstanding of gay sexuality today.
“Barebacking is a right,” gay anthropologist Eric Rofes once wrote. “After all, practically every straight guy in the world gets to do it without being told they are irresponsible, foolish, or suicidal… Barebacking is liberation. Barebacking is defiance.”
How foolish, prescient, liberating, enlightening or destructive barebacking may ultimately become is something that may only be revealed in the next chapter of our gay community’s troubled history.
(Photo of Dawson and Jesse O’Toole courtesy of Max Sohl and edited for content. Other images courtesy of Treasure Island Media [NSFW].)
TWO MORE POSTS ON BAREBACKING and/or GAY SEX:
“Your Mother Liked it Bareback” loses all patience with the finger pointing and judgments being hurled around between gay men when it comes to choices about unprotected sex. In short, it asks us to broaden what it means to have “safer sex,” and to acknowledge there are now many prevention techniques that do not involve condoms. Check it out.
“Why I Stopped Going to the Baths” is a riot, explaining my decision to stop, well, going to the baths. Any posting that begins with “The last time I went to the baths I stepped in poop,” can’t be all bad, right?
Tags: aids, barebacking, culture, gay, hiv, meth, Recreation, research, serosorting, Sexuality, testing
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